Osteoporosis: the silent disease

Osteoporosis is a common condition that adversely affects bone health for people 50 years and older. And with age, bones become brittle and fragile, with increased risks of fractures in locations such as the wrist, spine and hip.

Osteoporosis typically develops without pain or other symptoms. Known as ‘The Silent Disease,’ a diagnosis often occurs following a painful fracture. It affects about 1 million Australians and 200 million people globally.

The frequency of osteoporosis and related complications is sobering:  50% of women and 25% of men >50 years of age will experience an osteoporosis–related fracture in their lifetime (4): and after a hip fracture, only 20% of people return to their prior physical function (1).

Principle causes of osteoporosis include menopause, age, medications and physical inactivity. These factors contribute to the loss of bone minerals, such as calcium, more rapidly than can be replaced by the body. Subsequently, bone density diminishes, and bone fragility is accelerated.

 

A solution to better bone health!

In addition to medication, appropriate types of exercise and physical activity can help maintain or improve bone health by increasing bone density and bone strength. And improved bone health reduces the risk of an osteoporotic fracture. Studies show that physical activity — especially for older women — is inversely associated with hip fracture risk.

 

What are the best exercises to improve bone health?

Weight-bearing and resistance exercises are the most effective at building bone strength and improving bone health if performed regularly (3,4,5).

1. Weight-bearing aerobic activities contribute to improved bone health by increasing bone mass and reducing the rate of bone density loss. Perform these activities in a standing position, which maximizes the weight and force that is exerted on your bones via gravity.

Examples of weight-bearing aerobic activities — which incorporate high intensity speed work — include jogging, stepping, skipping, brisk hill walking, and impact aerobics.

2. Resistance strength training will also increase bone density and improve bone health. This is due to the fact that your joints are moved against a form of resistance such as free weights (hand/ankle weights), machines, or therabands.  Moreover, you can use your body weight as resistance to perform exercises such as pushups, step ups, and squats.

If you have not lifted weights before, it is advisable to begin with low-load weights and progressively build the load and resistance to avoid injuries. And, in order to maximize the benefits of resistance strength training and improve bone health, exercises should be performed with high loads of 8-10 repetitions, 3 sets, 3 times a week (5).

Also consider performing stability and balance exercises while standing. Steady balance reduces the risk of falling and the risk of bone fractures.

Non-weight-bearing exercises — such as swimming and cycling — can help build and maintain strong muscles and a cardiovascular system.  Yet, these types of exercise are not the best to sustain and improve bone health. Additionally, walking as a form of exercise is not able to modify the loss of bone density when compared with more intense forms of weight-bearing exercises (5).

 

Exercise examples

Below are two exercises that will help you get started:


1  |  TRICEPS DIPS

1. Sit on the edge of a chair, step or box, with your hands on the seat next to your body and move your buttocks forwards to the edge.

2. Walk your feet forward so your legs extend in front of you with knees bent.

3. Use your arms to slowly lower your body directly down towards the floor by bending at the elbows.

4. Lift yourself up by straightening your elbows to complete the triceps dip.

5. Keep your eyes level and look forwards.

triceps dip

 


2  |  STEP UPS (ONTO A BOX OR CHAIR)  

1.Stand in front of a sturdy chair or box.

2. Place one foot onto the chair or box and step up bringing both feet together on the box/chair with both legs straight and standing tall.

3. Keep the knee in line with the foot, and behind the toes as you step up.

4. Step back down with the same leg and then repeat with the other leg.

step ups


References

  1. Lane NE. Epidemiology, etiology, and diagnosis of osteoporosis, Am Journal Obstet Gynecl. 2006; 194 (2 Suppl): S3-S11
  2. Pouresmaeili F, Kamalidehghan B, KamareheiM, Goh YM. A comprehensive overview on osteoporosis and its risk factors. Ther Cli Risk Manag. 2018; 14: 2029-2049. Published 2018 Nov 6
  3. Avin K, Nithman R, Osborne R, Betz S, Lindsey C, Hartley G (2022) Essential Components of Physical Therapists Management of Patients with Osteoporosis: A Delphi Study. Journal of Geriatric Physical Therapy, 45(2), 120-126
  4. www.health.harvard.edu Osteoporosis–a guide to prevention and treatment. (2020) ISBN 978-1-61401-242-9
  5. Beneditti, MG et al (2018) The effectiveness of Physical Exercise on Bone Density in Osteoporotic Patients: Review Article. BioMed Research International, Article ID 4840531. https://doi.org/10.1155/2018/4840531
  6. Michael J. LaMonte, et al.  Association of Physical Activity and Fracture Risk Among Postmenopausal WomenJAMA Netw Open. 2019;2(10):e1914084. doi:10.1001/jamanetworkopen.2019.14084